A comparison of endoscopic and microscopic inlay butterfly cartilage tympanoplasties and their educational utility

Abstract

Objectives Inlay butterfly cartilage tympanoplasty (IBCT) is a simple grafting technique. Endoscopy facilitates visualization by eliminating blind spots. We analyzed the outcomes of IBCT using both endoscopic and microscopic approaches, and assessed how trainees perceived the educational opportunities afforded. Materials and methods Sixty patients who underwent IBCT were allocated to Group I (n = 30; microscopic IBCT) and Group II (n = 30; endoscopic IBCT) by the dates of their visits. Anatomical success was defined as an intact, repaired tympanic membrane; functional success was defined as a significant decrease in the air–bone gap. Postoperative discomfort was analyzed using a visual analog scale (VAS). Thirteen trainees completed structured questionnaires exploring anatomical identification and the surgical steps. Results The surgical success rates were 96.7% in Group I and 100% in Group II. We found no between-group differences in the mean decrease in the air–bone gap or the extent of postoperative discomfort. Significant postoperative hearing improvements were evident in both groups. The mean operative time was shorter when the microscopic approach was chosen (17.7±4.53 vs. 26.13±9.94 min). The two approaches significantly differed in terms of the identification of external and middle ear anatomical features by the trainees, and their understanding of the surgical steps. Conclusion Both endoscopic and microscopic IBCT were associated with good success rates. The endoscopic approach facilitates visualization, and a better understanding of the middle ear anatomy and the required surgical steps and thus is of greater educational utility.

Endoscopic or Microscopic Tympanoplasty Advantages and Disadvantages: A Theory Domain Systematic Review

“…14 Hashim et al (2020) 40 Retrospective Endoscopic and microscopic IBCT were associated with good success rates. The endoscopic approach facilitates visualization, and a better understanding of the middle ear anatomy and the required surgical steps.…”

Training in Endoscopic Ear Surgery: A Scoping Review

“…Twenty‐eight studies were included in accordance with the eligibility criteria (Table II). 4,8,10,14–38 Primary population sizes ranged from a single individual, featured in 10 studies, 4,15,20,23,24,27,29,30,32,34 up to a maximum of 70 included in Denton et al (2022) 37 . The most popular study design was retrospective, 12 of which were included 4,10,15,16,23,27–30,32,34,36 .…”

“… 4,8,10,14–38 Primary population sizes ranged from a single individual, featured in 10 studies, 4,15,20,23,24,27,29,30,32,34 up to a maximum of 70 included in Denton et al (2022) 37 . The most popular study design was retrospective, 12 of which were included 4,10,15,16,23,27–30,32,34,36 . Quality assessment resulted in five “good,” 19 “fair” and four “poor” ratings (Appendix S3).…”

Comparison of Inlay Cartilage Butterfly and Underlay Temporal Fascia Tympanoplasty

“…The results were confirmed by others. 7 - 13 A randomized clinical trial comparing this technique with underlay fascia tympanoplasty demonstrated similar efficacy in graft take and audiometric outcomes, with advantages of the butterfly in terms of ease and speed of execution and better recovery (instant hearing recovery, less postoperative care, and less pain), making it a cheaper procedure for the health system. 14 …”

“…The results were confirmed by others. [7][8][9][10][11][12][13] A randomized clinical trial comparing this technique with underlay fascia tympanoplasty demonstrated similar efficacy in graft take and audiometric outcomes, with advantages of the butterfly in terms of ease and speed of execution and better recovery (instant hearing recovery, less postoperative care, and less pain), making it a cheaper procedure for the health system. 14 The objective is to carry out a systematic review and metaanalysis of studies that compared the effectiveness of butterfly cartilage inlay tympanoplasty (BCIT) with traditional temporal fascia underlay tympanoplasty (TFUT) and, with the increase in statistical power conferred by this methodology, to identify whether there is a difference in anatomic and/or functional efficacy between the techniques and whether there are predictive factors for success.…”